I recently met with 30 healthcare leaders from across the country and asked how many of them considered themselves to be ethical leaders. Perhaps unsurprisingly, everyone raised their hand. When asked how they knew they were ethical leaders, they gave responses like, “I have integrity,” or “I am honest.” As we continued to discuss the meaning of ethical leadership, it became apparent to them that these character traits were only part of the equation; there is more to being an ethical leader than having specific personality traits.
People often point to particular virtues or personality traits they see in themselves or their role models as indicative of ethical leadership. However, there is more to it than that. First and foremost, it is about doing the right thing or taking the right action. It is about leading through ethical behaviors and is something that takes practice.
Ethical behavior can be thought of as a moral muscle, and, just like any muscle, without regular exercise, it will atrophy. It is only when a person’s character traits, such as integrity and honesty, are translated into ethical behaviors that we can truly experience ethical leadership. The focus of this article is on the following vital ethical behaviors:
- Demonstrating ethics is a priority.
- Communicating clear expectations for ethical practice.
- Practicing ethical decision-making.
- Using the right incentives to drive behavior.
- Supporting an ethics program.
Though this behavioral model of ethical leadership draws from that proposed by the Veterans Health Administration’s National Center for Ethics in Health Care’s IntegratedEthics initiative (see “Ethical Leadership: Fostering an Ethical Environment & Culture,” ethics.va.gov/Elprimer.pdf), it breaks from that model in two main ways: drawing out the importance of incentives for driving behavior and emphasizing that behaviors, in combination with character traits, are what make an individual an ethical leader.
Demonstrating Ethics Is a Priority
Ethics has a trickle-down effect. While most leaders will say they are ethical, it is crucial that they demonstrate ethics is important to them. Without doing so, team members might infer that doing
the right thing or behaving in a way that aligns with organizational values is not essential to the work they do.
Leadership Behaviors and Sample Actions
There are many ways for leaders to demonstrate, to their team and other stakeholders, that ethics is a priority. One approach can be as easy as leaders telling team members during meetings that ethics is important to them. However, consistent actions must follow those statements, such as being open to speaking about ethical issues with team members and stressing ethical practice, even in times of stress.
Communicating Clear Expectations for Ethical Practice
There are daily pressures on organizations to yield the best results, whether they be clinical or financial. These demands can sometimes push the boundaries of what is ethically acceptable. We all have heard unfortunate stories of leaders pressuring their teams to meet goals, with the misunderstanding that they can do “whatever it takes” to achieve them. Ethical leaders are clear with their team members about their expectations for ethical practice. When expectations are clear, ethical leaders create a psychologically safe and ethical culture where team members can speak up, ask questions and, most importantly, express concerns when leaders ask them to perform actions they are ethically unsure about.
Practicing Ethical Decision-Making
Healthcare decision-making is tough, especially when attempting to identify and address the values-based components of a decision. It is crucial, therefore, that ethical leaders use a consistent framework to address ethical issues. In doing so, they can provide a clear rationale to their team as to why a particular decision was made and on what ethical grounds.
Often, by using a systematic framework, a leader can identify issues outside of their scope or comfort level, which prompts them to seek out the assistance of someone with ethics expertise. The complexity of ethical issues and demand for ethical decision-making has likely led to the growth of ethics programs within healthcare organizations, which hire ethicists to make ethics expertise more readily available to healthcare leaders.
Using the Right Incentives to Drive Behavior
An institution’s mission, vision and values are the core of all decision-making within an organization and fundamental to any ethical leader’s decision-making process. Ethical leaders ensure team members are held accountable for their actions when they make decisions that are inconsistent with the organization’s mission, vision and values. The key here is not to punish the employee but, rather, to raise awareness of the importance of the organization’s core values and why making decisions based on those values is crucial.
In addition, it is essential that ethical leaders support team members who exude organizational values. Team members learn behavior both from seeing accountability for violation of values and from positive examples of team members who are living out the organization’s values through their behaviors and decision-making.
Supporting an Ethics Program
We all know that any program lacking leadership support will likely be unsuccessful. This is also true of ethics programs. Leaders should understand the role and importance of ethics resources within their organization. It is also essential to understand the distinction between ethics-based resources and those used in compliance, risk or legal departments.
Ethics programs and resources aim to address and guide values-based decisions. Part of a leader’s ethical behavior involves supporting team members’ access to and participation in these resources. For example, leaders should support team members when they want to attend education events put on by the ethics program or when team members want to engage in initiatives developed by the ethics program.
Moving Forward
Being an ethical leader requires we all do the work, but to do so successfully necessitates clear guidance. A first step is to provide resources to support the growth of leaders’ ethical muscles. This includes assessments for individuals about ethics leadership, such as ACHE’s Ethics Self-Assessment (ache.org/Ethics), and creation of an ethical leadership development training program. Such a program will identify organization and leader-specific growth opportunities, which should be incorporated into yearly development plans (see “Leadership Behaviors and Sample Actions” on Page 28).
It might also be helpful to identify how ethical leadership could be integrated into existing training programs within the institution such as case scenarios that highlight ethical challenges a leader may encounter in their role. Furthermore, hiring processes that recognize the character of the individuals in addition to demonstrated behaviors can be effective.
Promoting ethical leadership provides numerous benefits for the individual leader and the organization. These include higher staff engagement and satisfaction, improved community image, decreased ethical scandals, and, in many cases, increased revenue and cost savings, especially in the long-term.
Successful organizations prioritize ethical leadership and create spaces and resources where leaders can learn to lead through ethical behaviors and fully develop their moral muscles.
Jason Lesandrini, FACHE, is assistant vice president, ethics, advanced care planning and spiritual health, Wellstar Health System, Marietta, Ga., and founder and principal of The Ethics Architect (jlesandr@gmail.com).